Wednesday, June 07, 2006

Questions, Questions

Is this even ethical?This Telegraph article touts the wonder of turning a piece of your brain off so that you can count large numbers quickly:

Ordinary people could be capable of extraordinary feats of mental agility by turning off part of the brain with magnetic fields, according to Australian scientists.

In the Hollywood film Rain Man, the character played by Dustin Hoffman counts 246 toothpicks at lightning speed when a waitress spills them in a heap on the floor of a diner....Participants in the study were presented with 50 to 150 random elements on a monitor.

Of the 12 participants, 10 improved their ability accurately to guess the number of elements immediately following TMS treatment to the left anterior temporal lobe, a skill that receded an hour later.

As a person who has spent a lot of time trying to get her left temporal lobe to work, this study seems to border on the insane. Artificially-induced autism is not something healthy people should want to pursue. My advice is to leave your brain turned on! I believe you will find that much more useful than counting large numbers at a single glance.

Of a Thursday evening in March, our overworked author and her overworked husband found "some rare couple time" together and found themselves "in a sudden rush of passion," in the course of which she "failed to insert her diaphragm." So she called up her doctor the next day to get a prescription for "Plan B," the hormone pill that prevents pregnancy if taken within 72 hours. Her ob-gyn, however, does not prescribe it, she found out, nor does her internist. The midwifery practice she had used before would prescribe Plan B, but not by phone, and she couldn't get an appointment that day. "I was pretty much out of options -- short of soliciting random Virginia doctors out of the phone book." So she decided to take her chances.

The author of the editorial seems stunned by this woman's willingness to blame Bush for Plan B not being sold over the counter rather than herself for not using birth control. In an autistic, hunks-of-brain-turned-off sort of way, my first reaction was to wonder why these three medical practices were unwilling to prescribe it over the phone. Could that be because it presents some dangers, and they feel that it is not a safe thing to do? I suspected so, which would seem to indicate a reason why it is not being sold over the counter yet.

Hunting around, I found a patient handout about plan B which seems to indicate that she could have gotten an appointment with her midwife the second day and still used it (manufacturer's recommendations are that the first pill should be taken within 72 hours, and also that there are circumstances during which it should not be used, such as if you may already be pregnant or if you have had unexplained bleeding). The doctors all probably do a pregnancy test and ask a few questions before prescribing it. Also, this more detailed set of instructions suggest that the patient be monitored for signs of ectopic pregnancy after use, because progestin-only birth control is known to produce a higher rate of ectopic pregnancies.

After looking at the high rate of adverse side effects (10% experienced dizziness, 23% experienced nausea, 17% experienced abdominal pain), I'm not sure that I would be taking this and if I were a doctor, I'd be worried about prescribing it over the phone and getting sued if someone got sick and had a car accident. After all, if the risk of pregnancy after one act of unprotected intercourse is 8% and this drug reduces that to 1%, you are not gaining that much. I wouldn't want to try to explain in court why I prescribed something over the phone that I knew would cause a potentially serious side effect like dizziness in 1 out of 10 women, when less than 1 out of 10 women would be expected to get pregnant in the first place.

I am also highly skeptical that adolescents should be able to buy this over the counter. It's one thing if they are getting it in a clinic, which could ask the questions and check up on them. It's another thing for them to be taking this at a young age, when they may still be developing, without any medical intervention. And apparently no one has assessed the cumulative effects of repeated use at a young age - which, let's get real - is going to happen if it is sold over the counter to teenagers. Anyway, I just thought I'd share the research with women out there, because this is something you want to know if you have a teenaged girl.

Update: Btw, in the original article the lady involved says that she was taking three prescription drugs, including one for high cholesterol. Those drugs can affect your liver. Drug interactions are nothing to be sneezed at, so I can absolutely understand why doctors might want to see her before prescribing Plan B. As someone who has been through the medical mill, I have come to appreciate the intricate offsets of risks that doctors must evaluate when prescribing drugs, especially multiple drugs.

The thing is, surgical abortions are at least safe. Doctors have the obligation to practice medicine in a conservative manner that avoids unnecessary risks. The woman writing the article seems to have leaped to the conclusion that doctors unwilling to prescribe this medication over the phone were doing so from some sort of religious objection:

Meanwhile, I hadn't even been able to get Plan B with a prescription that Friday, because in Virginia, health-care practitioners apparently are allowed to refuse to prescribe any drug that goes against their beliefs. Although I had heard of pharmacists refusing to fill prescriptions for birth control on religious grounds, I was dumbfounded to find that doctors could do the same thing.

It's extremely unlikely to be so. I think she owes an apology to the medical profession, at least. I also think she had a good ground for a lawsuit if someone did prescribe it for her over the phone and had an adverse reaction. The lady, btw, is a lawyer.

MOM, I don't know if you read the original piece about Plan B; the author's jaw dropping self-centeredness and pathetic attempt to shift the blame for her "dilemma" onto someone else was positively disgusting. The concept that "Plan B" might have been unacceptable to her health care providers for medical reasons occurred to me as it did to you....but the author was content to leave the reason unexplored so she could use this event as a vehicle for bashing: Bush, religion and conservatives. A transparent and contemptible ruse. With friends like this, pro-choice advocates need no enemies.

"Why is it that most women who get stuff printed are world-class whiners?"

I read that wail of BDS in the Washington Pest's "Outlook" section last Sunday,(actually, my parrot read it, my cranium spends enough time in rotating magnetic fields next to generators and such, don't need much more to go out of order...

I had a really pithy comment all typed in and ready to send yesterday...and then blogger went down. Damn thing.

The WaPo is now being called to account for the fact that this woman's story is just a bit too convenient. A 40-something who just happens to get pregnant after ONE epsiode of unprotected sex? A frantic search that occurred as the weekend approached and there was no other option? The author's convenient forgetfulness about the ready availability of Plan B at ANY Planned Parenthood? The coincidental presence of a throng of angry Christian protesters shoving disturbing photos at her as she soulfully made her way to the abortion clinic?

Is anybody else thinking "Rathergate"?

It is surely impossible to locate Ms. Dana L. for further comment or questions, since she is likely "concerned for her family and protecting her anonymity" (after telling such collossal lies, I guess I'd be too ashamed to show my face, too).

As for me, I'm prepared to dismiss the whole thing as having more air and less substance than a cheese souffle.

TG, perhaps you should do some investigative reporting on this one. Go riffle through a few desks in the WaPo newsroom, bring back the stash and we'll do a forensic analysis on it. I suspect it might be a toxic mixture of FAAR and MPCS (that's Feminist Anger Avoidance Reaction and Maximized Political Correctness Syndrome), but we shouldn't just jump to conclusions like the lady in the article.

I am unwilling to maintain without proof that this is all a lie. I have known a few people this idiotic. At my best (worst?), I believe I can transcend the dingbatry of this story as told - but on reflection, I do realize what I have done. I do not write columns claiming that the entire medical profession and Bush are engaged in a massive conspiracy against my interests because they're old meanies.

I would like to see the AMA take WaPo to task for printing these allegations against doctors without even consulting a doctor. Surely the editorial board should provide some doctor the space to explain why they might not be engaged in a vast rightwing conspiracy when they refuse to prescribe for you over the phone. There is such a thing as responsible journalism - and this does not fit into that category.

I think we all know that a man coming up with such a story - not using protection, and then complaining because he had to pay for an abortion and take a day off from work would get his skin ripped off, tanned, and mounted on the wall of the WaPo newsroom.